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NPI 1316003668 · Developmental Disabilities Clinic/Center · Jacksonville, NC
Provider details
- NPI number
- 1316003668
- Entity type
- Organization
- Primary specialty
- Developmental Disabilities Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Linda Gibson, Director(910) 455-6724
- License
- MHL067026 (NC)
Specialties & taxonomies
Ambulatory Health Care Facilities
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility320900000XLicense MHL067026 (NC)
Residential Treatment Facilities
Practice location
106 Grantham Ln
Jacksonville, NC 28546-8150
Phone: (910) 455-4480
Approximate (ZIP-level) locationGet directions
Mailing address
180 Coastal Ln
Jacksonville, NC 28546-6761
Registry dates
- Enumerated
- 2006-12-29
- Last updated
- 2015-06-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.